Koji Matsuo1, Yutaka Takazawa2, Malcolm S Ross3, Esther Elishaev4, Mayu Yunokawa5, Todd B Sheridan6, Stephen H Bush7, Merieme M Klobocista8, Erin A Blake9, Tadao Takano10, Tsukasa Baba11, Shinya Satoh12, Masako Shida13, Yuji Ikeda14, Sosuke Adachi15, Takuhei Yokoyama16, Munetaka Takekuma17, Shiori Yanai18, Satoshi Takeuchi19, Masato Nishimura20, Keita Iwasaki21, Marian S Johnson22, Masayuki Yoshida23, Ardeshir Hakam24, Hiroko Machida25, Paulette Mhawech-Fauceglia26, Yutaka Ueda27, Kiyoshi Yoshino27, Hiroshi Kajiwara28, Kosei Hasegawa29, Masanori Yasuda30, Takahito M Miyake31, Takuya Moriya32, Yoshiaki Yuba33, Terry Morgan34, Tomoyuki Fukagawa35, Tanja Pejovic36, Tadayoshi Nagano37, Takeshi Sasaki38, Abby M Richmond39, Miriam D Post39, Mian M K Shahzad7, Dwight D Im40, Hiroshi Yoshida23, Kohei Omatsu41, Frederick R Ueland22, Joseph L Kelley3, Rouzan G Karabakhtsian42, Lynda D Roman25. 1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, USA. Electronic address: koji.matsuo@med.usc.edu. 2. Department of Pathology, Cancer Institute Hospital, Tokyo, Japan. 3. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, MaGee-Womens Hospital, University of Pittsburgh, USA. 4. Department of Pathology, MaGee-Womens Hospital, University of Pittsburgh, USA. 5. Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan. 6. Department of Pathology, Mercy Medical Center, Baltimore, USA. 7. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Moffitt Cancer Center, University of South Florida, USA. 8. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Montefiore Medical Center, USA. 9. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Colorado, USA. 10. Department of Obstetrics and Gynecology, Tohoku University, Miyagi, Japan. 11. Department of Obstetrics and Gynecology, Kyoto University, Kyoto, Japan. 12. Department of Obstetrics and Gynecology, Tottori University, Tottori, Japan. 13. Department of Obstetrics and Gynecology, Tokai University, Kanagawa, Japan. 14. Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan. 15. Department of Obstetrics and Gynecology, Niigata University, Niigata, Japan. 16. Department of Obstetrics and Gynecology, Osaka Rosai Hospital, Osaka, Japan. 17. Department of Gynecology, Shizuoka Cancer Center, Shizuoka, Japan. 18. Department of Obstetrics and Gynecology, Kurashiki Medical Center, Okayama, Japan. 19. Department of Obstetrics and Gynecology, Iwate Medical University, Morioka, Japan. 20. Department of Obstetrics and Gynecology, Tokushima University, Tokushima, Japan. 21. Department of Obstetrics and Gynecology, Aichi Medical University, Aichi, Japan. 22. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Kentucky, USA. 23. Department of Pathology, National Cancer Center Hospital, Tokyo, Japan. 24. Department of Pathology, Moffitt Cancer Center, University of South Florida, USA. 25. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, USA. 26. Department of Pathology, University of Southern California, Los Angeles, USA. 27. Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan. 28. Department of Pathology, Tokai University, Kanagawa, Japan. 29. Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan. 30. Department of Pathology, Saitama Medical University International Medical Center, Saitama, Japan. 31. Department of Obstetrics and Gynecology, Kawasaki Medical School, Okayama, Japan. 32. Department of Pathology, Kawasaki Medical School, Okayama, Japan. 33. Department of Pathology, Kitano Hospital, Osaka, Japan. 34. Department of Pathology, Oregon Health & Science University, USA. 35. Department of Pathology, Iwate Medical University, Morioka, Japan. 36. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Oregon Health & Science University, USA. 37. Department of Obstetrics and Gynecology, Kitano Hospital, Osaka, Japan. 38. Department of Pathology, The University of Tokyo, Tokyo, Japan. 39. Department of Pathology, University of Colorado, USA. 40. Department of Gynecology, Mercy Medical Center, Baltimore, USA. 41. Department of Gynecology, Cancer Institute Hospital, Tokyo, Japan. 42. Department of Pathology, University of Kentucky, USA; Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, USA.
Abstract
OBJECTIVE: To examine significance of sarcoma dominance (SD) patterns in uterine carcinosarcoma (UCS). METHODS: This is a secondary analysis of multicenter retrospective study examining women with stages I-IV UCS who underwent primary surgery. SD was defined as >50% of sarcoma component in uterine tumor. SD patterns were grouped as homologous sarcoma without SD (homo/non-dominance, n = 351), heterologous sarcoma without SD (hetero/non-dominance, n = 174), homologous sarcoma with SD (homo/dominance, n = 175), and heterologous sarcoma with SD (hetero/dominance, n = 189), and correlated to tumor characteristics and survival. RESULTS: SD patterns were significantly associated with age, body habitus, carcinoma type, tumor size, depth of myometrial invasion, and nodal metastasis (all, P < 0.05). On univariate analysis, SD was associated with decreased progression-free survival (PFS) and cause-specific survival (CSS) in homologous cases (both, P < 0.05) but not in heterologous cases. On multivariate models, both homologous and heterologous SD patterns remained independent prognostic factors for decreased PFS (adjusted-hazard ratio [HR] ranges: homo/dominance 1.35-1.69, and hetero/dominance 1.47-1.64) and CSS (adjusted-HR ranges: 1.52-1.84 and 1.66-1.81, respectively) compared to homo/non-dominance (all, P < 0.05). Among stage I-III disease, when tumors had SD, adding radiotherapy to chemotherapy was significantly associated with improved PFS (adjusted-HR: homo/dominance 0.49, and hetero/dominance 0.45) and CSS (0.36 and 0.31, respectively) compared to chemotherapy alone (all, P < 0.05); contrary, this association was not observed with absence of SD (all, P > 0.05). CONCLUSION: In UCS, SD impacts survival in homologous but not in heterologous type. Regardless of sarcoma types, SD was associated with decreased survival in UCS; adding radiotherapy to chemotherapy may be an effective postoperative strategy.
OBJECTIVE: To examine significance of sarcoma dominance (SD) patterns in uterine carcinosarcoma (UCS). METHODS: This is a secondary analysis of multicenter retrospective study examining women with stages I-IV UCS who underwent primary surgery. SD was defined as >50% of sarcoma component in uterine tumor. SD patterns were grouped as homologous sarcoma without SD (homo/non-dominance, n = 351), heterologous sarcoma without SD (hetero/non-dominance, n = 174), homologous sarcoma with SD (homo/dominance, n = 175), and heterologous sarcoma with SD (hetero/dominance, n = 189), and correlated to tumor characteristics and survival. RESULTS:SD patterns were significantly associated with age, body habitus, carcinoma type, tumor size, depth of myometrial invasion, and nodal metastasis (all, P < 0.05). On univariate analysis, SD was associated with decreased progression-free survival (PFS) and cause-specific survival (CSS) in homologous cases (both, P < 0.05) but not in heterologous cases. On multivariate models, both homologous and heterologous SD patterns remained independent prognostic factors for decreased PFS (adjusted-hazard ratio [HR] ranges: homo/dominance 1.35-1.69, and hetero/dominance 1.47-1.64) and CSS (adjusted-HR ranges: 1.52-1.84 and 1.66-1.81, respectively) compared to homo/non-dominance (all, P < 0.05). Among stage I-III disease, when tumors had SD, adding radiotherapy to chemotherapy was significantly associated with improved PFS (adjusted-HR: homo/dominance 0.49, and hetero/dominance 0.45) and CSS (0.36 and 0.31, respectively) compared to chemotherapy alone (all, P < 0.05); contrary, this association was not observed with absence of SD (all, P > 0.05). CONCLUSION: In UCS, SD impacts survival in homologous but not in heterologous type. Regardless of sarcoma types, SD was associated with decreased survival in UCS; adding radiotherapy to chemotherapy may be an effective postoperative strategy.
Authors: Koji Matsuo; Malcolm S Ross; Mayu Yunokawa; Marian S Johnson; Hiroko Machida; Kohei Omatsu; Merieme M Klobocista; Dwight D Im; Shinya Satoh; Tsukasa Baba; Yuji Ikeda; Stephen H Bush; Kosei Hasegawa; Erin A Blake; Munetaka Takekuma; Masako Shida; Masato Nishimura; Sosuke Adachi; Tanja Pejovic; Satoshi Takeuchi; Takuhei Yokoyama; Yutaka Ueda; Keita Iwasaki; Takahito M Miyake; Shiori Yanai; Tadayoshi Nagano; Tadao Takano; Mian Mk Shahzad; Frederick R Ueland; Joseph L Kelley; Lynda D Roman Journal: Surg Oncol Date: 2019-02-07 Impact factor: 3.279